Have you ever needed a kick in the butt? Some type of push that motivates change is what a kick in the butt is meant to do. Sometimes the push works, sometimes the push backfires. Most of the time, a push, a nudge or a shove in the right direction is what someone needs. However, the one who does the pushing is usually risking retaliation. Is the risk worth it? Absolutely, especially when it comes to getting someone to quit a destructive addiction, a kick in the butt can be a life saver.

Recently, I kicked a patient’s butt. She came into my office smelling like an ashtray. I said to her, “How do you expect to feel better if you continue to smoke?” Her immediate response was that she did not smoke that much, only “8 per day”. I responded by saying , “Well, that is more than most people like me who do not smoke.” After pondering what I just said, she left rubbing her butt a little after that good, stiff kick. The next visit (yes, she did come back to see me) she gave me a huge hug and thanked me for pushing her to quit smoking. “See, I do not smell like an ashtray” she said. That lifestyle change is the most important one she will ever make. Each day of abstinence from smoking is a step towards being pain free.

That’s right; smokers cannot expect to be pain free because smoking causes pain. Smoking damages discs in the spine, cartilage in the joints, nerves in the limbs. All this damage makes smoking the single most common denominator in my chronic pain population. I would even venture to guess that if it was not for smoking (and obesity) I would be out of business as a pain specialist. Surprisingly, most people do not connect smoking with pain. People connect smoking with cancer, lung disease, and maybe heart disease. But when I tell a patient that his/her spinal discs have rapidly degenerated because of smoking, that person gets a deer-in-the- headlights look of shock on his/her face. The next thing out of his/her mouth is usually, “Really, no one has ever told me that”. After being in and out of doctor’s office because of a painful condition, I find it hard to believe that “no one” has ever suggested to this patient to quit smoking in an effort to stop the painful process. Maybe the patient chose not to hear the suggestion or maybe “no one” ever risked giving a patient a kick in the butt. Either way, the time has come to get tough on smokers. No more excuses.

Here in California, the public health department has a “No Butts” program which includes a smoker’s hotline and information for the public and health personnel about kickin’ the butts. Help is out there. Locally, community hospitals often have “quit smoking” classes and support groups. However, unless someone is pushing a smoker in the right direction, these addicts have little motivation to stop the behavior of destruction. With a new year approaching, now is the perfect time to give someone you know a kick in the butt. Tell a friend or family member to “kick the butts now because the New Year can bring a New You”. Kick hard, kick often, and share the knowledge.

The bedroom is not just about sex; it’s about sleep. That’s right, sleep, a rejuvenating weapon against stress and fatigue. But sometimes, those little aches and pains become a barrier between you and a good night’s sleep. No, don’t reach for the pill bottle. A perfectly placed pillow may be all that you need. Side sleepers, stomach sleepers, and back sleepers; cushioning works for all types of sleeping. Let’s talk pillow strategy.

SIDE SLEEPERS

Most people are side sleepers. This position is usually the most comfortable for those with back pain, especially when the knees are pulled close to the chest—the fetal position. However, the shapely curves of your womanly figure can be problematic while sleeping on your side. Here are some strategies to bring you a more comfortable night’s sleep.

• Use a pillow (at least 5” thick) between your knees because our hips are wider than the knees, so a pillow here insures proper alignment of the spine.
• Use a pillow thick enough to fill the space between the head and shoulder tip. Again, proper alignment is gained with a pillow to fill this gap, without this you might wake up with a kink in your neck.
• Rest your upper arm on cushion like a body pillow. The upper arm needs support; otherwise, gravity pulls on the shoulder or tugs on the sensitive nerves in your neck.
• Try a small towel or soft, small pillow at your waist because our hips are wider than our waist (usually!?!), a gap is created and gravity fills the gap by misaligning our spine.
• Do not sleep on your side with a thin, flat pillow supporting your head. The head/neck will reach for the pillow in order for the head to rest on the pillow. Stretching and bending your neck all night will cause a pain in the neck.

STOMACH SLEEPERS

This position is favored by some for a change of pace; although, the neck will not favor this way of sleeping. Also, lying on the stomach can be uncomfortable for those with back pain because tightness around the hips causes extra strain in the low back. But, one key pillow placement may be all that you need to make stomach sleeping work for you.

• Try a pillow or stack of pillows under your stomach and chest. The extra height of the torso above the mattress will flex the hip and ease the back strain

BACK SLEEPERS

Again, this position can be uncomfortable for your lower back because your hips are too tight from sitting all day long. With proper pillow placement, sleeping on your back can actually be very comfortable.

• Use a thin pillow under your head. Very little gap exists between the back of the head and shoulders in this position; therefore, a thin pillow is required for good alignment.

• Try to support your knees on a few pillows. Remember, when the knees are closer to the chest (like a fetal position), back discomfort is eased.

ALL SLEEPERS

Now, you may be visualizing yourself in bed surrounded by pillows that create a barrier between you and your loved one (see page 65 in my book, High Heels to Hormones: A Woman’s Guide to Spine Care). Rest assured, just a few strategic pillows will not prevent a little romance and will provide you some rejuvenating sleep. Hopefully, you noticed the common denominator for the use of pillows—alignment. If your spine spends a whole night out of alignment, you will have pain. No matter if you sleep on your side, sleep on your stomach, or sleep on your back, body positioning is the key to comfort. If you change position throughout the night, keep some pillows handy that you can grab and place strategically. Waking up in pain is no fun. So, work with your curves, fill the gaps, and sleep well tonight because pillow talk just makes sense.

Faith comes in many forms: a faithful friend, faith in expert advice, and faith in a higher power. When it comes to living with chronic conditions, faith can heal in many ways. Some draw on faith for strength and comfort. Some use faith to distract from the suffering. Others use faith to find hope and solstice. How do you use faith for healing?

That question was posed recently by The Washington Post. I see faith used in many ways by my patients. By far, the most common form of faith is found in the act of communing. Communing is a type of interaction and communication. Whether one communes with a friend or with a higher power, both ways provide support in times of need. I invite you to read further about Communing and Healing.

When I need a restorative force in my life, I turn to the natural world. Upon looking at a beautiful vista, Ralph Waldo Emerson once said, “Now let me die, for I am happy”. I have certainly felt that way when witnessing something divinely beautiful, like the time when I watched the sunrise over the Grand Canyon (see picture) or the time when I skied through a quiet stretch of forest after a fresh snowfall. Yes, God has revealed himself to me through nature.

I also remember my darkest day when the will to live was kicked out of me. On that day, I took a walk and let the healing powers of the wilderness wash over me. At that moment of seemingly endless suffering, I worshiped God’s creation in God’s cathedral—the wilderness. Somehow, the connection with the trees, the water, the wind, and those that live in the woods reminds me that my problems are small and surmountable.

Recently, a special series about the National Parks by Ken Burns aired on public television. The first episode was fittingly called “The Scriptures of Nature”. John Muir, Ralph Waldo Emerson, and Teddy Roosevelt all felt compelled to preserve the holiest of lands for future generations to have some way to feel grounded. We all need to feel grounded in times of distress and suffering. The natural world has inspired many cultures across the history of time. Such inspiration can only be called one thing—the Gospel of Nature. This gospel says that a spiritual communion awaits you in God’s cathedral. Thus ends the lesson, Amen.

Any doctor who prescribes opiate painkillers is required by the Drug Enforcement Administration (DEA) to monitor for inappropriate use of the prescription drugs. Prescription drug abuse is a very big problem in this world and prescribing doctors should feel morally obligated to make sure the drugs he/she prescribes are not doing any harm. Patients should also welcome monitoring because it improves safety by looking for hidden problems. Two types of monitoring are used by most doctors: Urine Drug Testing and Prescription Monitoring Systems. I use both in my practice. By monitoring, I am able to identify addiction behavior, prescription abuse, prescription non-compliance, and dangerous poly-chemical use. Monitoring is not fool-proof or perfect. The information gathered serves as pieces to a puzzle and means to an open, honest dialogue. In this imperfect world, patient monitoring is necessary for anyone who treats pain with chemicals.

With that said, those who prescribe marijuana should also be concerned about patient monitoring. Many people are using multiple substances from multiple doctors. The interactions between these mind-altering substances can have serious personal and public safety consequences. Just as I do not allow those who use opiates to drink alcohol, I do not allow those who use opiates to use marijuana and vise-a-versa. Mixing chemicals exponentially increases the risk for disaster.

Now that the federal government has relaxed its regulations about medical marijuana, we should all start wondering about the implications. Are those who prescribe marijuana monitoring properly? Are those who use marijuana mixing it with other mind-altering substances? Is that driver next to you driving under the influence? Until something bad happens, Americans have become comfortably numb to the use of chemicals from caffeine to morphine and now to marijuana.

Recently, a 17 year old died from a heroin over-dose. That woke-up this town and local law enforcement to take a harder look at what we allow to happen right under our nose. The U.S. Center for Disease Control and Prevention has reported that prescription opioid painkiller deaths are higher than deaths from illegal drugs such as heroin and cocaine. But don’t let anyone tell you otherwise, all chemicals have the potential to cause harm. Any chemical use can quickly turn into a harmful or dangerous situation if not properly monitored and regulated.

As a doctor, I am happy to diligently monitor in order to protect my patients and the public from the harmful effects of chemicals. I hope that the federal government does not completely give in to the wants of the people and relax all regulations about mind-altering substances. Of course, the government does not have an obligation to do no harm. But, I do.

Have you ever been in a starkly white room waiting to see the doctor? Feels a bit uncomfortable and harsh, such an environment is not conducive to comfortable openness. If any place, the rooms where hearts are mended or broken should be warm and inviting. The use of colors can break through the barriers of ice-like white. Everyone has a favorite color. Some love the entire spectrum. Whichever colors are chosen, your spaces should be colored.
Colors portray personality.
Colors set a mood.
Colors embrace the occupants.
Colors provoke thought.
Colors provide accent.
Colors attract the mind.
Colors evoke memories.
Colors stimulate ideas.
Colors dazzle the eyes.
Colors comfort the soul.
Come see the new colors in my new office and let me know what you think:
900 East Main Street #200
Grass Valley, CA 95945

I look forward to seeing you in my new space for healing.

A 36 year old woman sees her doctor about a persistent aching pain in her elbow. She does not recall a particular injury; but, as a mother of two children, she often ignores her own aches and pain until she cannot take it anymore. After a brief examination of her elbow, the doctor determines that she has lateral epicondylitis—tennis elbow. After exhausting conservative treatment for tennis elbow, she undergoes a procedure. Most unfortunately for everyone involved, the procedure goes terribly awry and the patient goes into complete cardiac arrest. After resuscitative efforts, this 36 year old mother is left with an automatic defibrillator implant and the same old elbow pain. At this point, this patient is referred to me. My examination reveals no pain to resisted wrist extension. However, the most significant findings are the positive Upper Limb Neurotension signs. My diagnosis is not lateral epicondylits. Rather, my diagnosis is nervous system sensitization of the upper limb quarter causing referred elbow pain.

Whoa! Let’s back this up a bit. What are Upper Limb Neurotension signs? We are accustomed to a popular Lower Limb Neurotension sign—the straight leg raise test. This lower limb test can be done with the patient is lying on her back and raising the straight leg up towards the ceiling. This maneuver creates tension in the lower limb nerves like the Sciatic nerve. If the nerve is sensitive from a disc herniation or stenosis, the angle that the leg can raise to is significantly impeded by pain along the nerve pathway. This common physical exam technique tests for lower limb nerve sensitization. Well, a nervous system exam can also include a series of Upper Limb Neurotension signs for the median, ulnar, radial, and even musculocutaneous nerve. Those who wish to learn more are encouraged to read The Sensitive Nervous System and Explain Pain by David Butler. According to David Butler, nervous system generated pain can masquerade not only as tennis elbow, but also a hamstring strain, an ankle sprain, and plantar fasciitis. Sometimes these pains do not resolve because no one addresses the nervous system involvement.

After insurance delays and more delays, this 40 year old mother of two is finally getting some relief with manual therapy that is concentrating on thoracic spine tractioning and mobilization. She also has a home exercise program centered around David Butler’s concept of nervous system “sliders and gliders”. Additionally, the defibrillator, a tremendous source of psychological distress, was removed. Although, the traumatic memories are still fresh and boil just underneath the surface of this 40 year old mother of two.

This initial elbow pain might have begun as a simple sensitization of the spinal cord at the cervical/thoracic junction or directly at the C6 nerve root. The trauma of prolonged resuscitation and chest compression expanded the sensitization to the thoracic spine because her arm pain became bilateral and more widespread. Recent literature has shown the effectiveness of thoracic manipulation for the treatment of cervical radiculopathy/radiculitis symptoms. The integral relationship of the upper thoracic spine with the lower cervical nerve roots is not to be ignored and should be addressed in anyone showing signs of central sensitization of the upper limb quarter.

Despite this dramatic scenario for a seemingly innocuous problem of tennis elbow, no one is to blame. The current medical system does not foster thorough examinations and complications do happen. This case should serve as a reminder to imagine all the possibilities before jumping to conclusions especially if it is match point.

Which state uses the most prescription drugs? The answer is West Virginia according to a recent article on Forbes.com. What is the top selling drug? Lipitor (a cholesterol lowering drug) is the top selling drug. What are the third most used drugs in America? Antidepressants are widely used and the third leading money maker for pharmaceutical companies. What does all of this say about America?

Looking at the leading state, West Virginia; the statistics show that 70% of people in West Virginia are obese. 25% of people in this state smoke. Well, those statistics say a lot about the reason why this state uses the most prescription drugs. Heart disease, obesity, diabetes; all of these problems are strongly linked to lifestyle habits, particularly nutrition. Did you notice that all the leading states tend to be in the South and Midwest? That trend cannot be a coincidence. Regional differences must be a very large factor in the prescription drug use trends. These regional differences could include environmental exposures, lifestyle habits, and possibly medical care trends.

So what does all of this say about America? One researcher put it very well that if anything there is a “greater emphasis on drugs” than there used to be here in America. That emphasis is growing with no end in sight unless we as Americans start embracing health.

“In the future, doctors will not prescribe medicines but will promote health”—Thomas Edison

The biggest hurdles to adequate pain control with medications are the side effects. Wouldn’t be nice to have a chronic pain treatment that did not have you “backed up and barfing“? Hypnosis treatment is an alternative treatment (not a cure) for chronic pain without all those nasty side effects. Recently, I interviewed a local expert in the field of hypnosis to treat pain. Please read my article about hypnosis for pain management and learn what he had to say about this mind-changing pain reliever. Since pain is an output signal from the brain, it makes sense to treat pain at the source–the brain.

Hypnosis for the management of pain is an effective, yet underutilized, alternative treatment. By learning the techniques of self-hypnosis, a patient can experience these benefits.

1. Reduction of overall pain intensity: Hypnosis has not proven to be a cure for chronic pain, but has consistently given patients some control over pain intensity.
2. Ability to manage breakthrough pain: Chronic pain has an underlying roar that is frequently intensified by breakthrough pain depending on things like activity level, weather, and stress. With self-hypnosis, patients are able to minimize environmental and psychological effects on the pain experience.
3. No side effects: Hypnosis has no side effects; unlike managing pain with medications that cause drowsiness, constipation, nausea, itchiness, hormone imbalances, memory problems, swelling, and more.
4. Reduction in medication use: Studies have shown that pain medication use significantly reduces when someone is regularly practicing self-hypnosis. Less is better.
5. Improved mental habits: Physical habits like how one puts on a pair of pants or how one walks are easy to see and, in turn, accept. A person’s life is shaped by habits; not only physical habits, but also by mental habits like how one reacts to criticism or how one responds to a deadline. Through the use of hypnosis, these mental habits are changeable. Hypnosis can change unhealthy thought patterns into healthy mental habits. Hypnosis can stop the mental landslide.

With all of these potential benefits, hypnosis might be worth a try. This chronic pain treatment is not some circus act. This treatment is real psychotherapy that can unleash the power of the brain.

Dr. Martin Seligman put forth some interesting theories about the origins of depression in his book Learned Optimism. Here is a summary of five major points in this wonderful book. In making these points and increasing the understanding about depression, he hopes that more people can then find a pathway to optimism and happiness.

1. Generation Depressed might be a reflection of a changing theme in children’s books. He points out that the 30 years ago the symbolic children’s book of was The Little Engine That Could which encourages hard work and optimism. But, now many children’s books are “about feeling good, having high-self esteem, and exuding confidence”. Please read on.
2. Generation Depressed might be a reflection of the “self-esteem movement”. Placing more emphasis on self-esteem and less emphasis on competition and hard work may be creating problems than good. Dr. Seligman wrote, “When these children confront the real world, and it tells them they are not as great as they have been taught, they will lash out…”. Those words are disturbing if you think about the possibility that this epidemic of depression could be our own doing. This leading psychologist believes that self-esteem should merely serve as a marker of mental health, not an end point. Teaching and supporting “unwarrantedly high self-esteem” may be setting people up for a major fall.
3. Generation Depressed is dominated by women. That is right; women are more likely to be depressed than men by a ratio of 2:1. Surely, some major clues to the origins of depression lie in this statistic. Many of have postulated about role conflicts and role differences. However, I resonated with Dr. Seligman’s explanation of the gender factor in depression. One word sums it up: rumination. Women tend to chew the cud, mull things over, brood, over analyze, reflect, contemplate, and think way too much. Men quite simply act when trouble strikes. Action protects men from amplifying depression. Rumination catapults women down a wave of depression.
4. Generation Depressed is self absorbed. Years ago, consumer choice did not exist. All refrigerators were white. All shoes were black or brown. And dinner was what mother put in front of you. Accepting was expected. Now, we have an over abundance of choice. Who chooses? The individual. Dr. Seligman calls this inflated sense of individuality the “maximal self”. The “maximal self” revolves around choice and self gratification. Our grandparents had the “Yankee self” that was “less preoccupied with how it felt” and more concerned with duty. The escalation of self (the egocentric) sets the tide of depression into motion especially when life throws a little disappointment into the mix.
5. Generation Depressed has no sense of duty. Being tethered to something bigger than self can help someone ride out the storm of adversity and hold back the tide of depression. What is bigger than self: family, country, God, and a sense of purpose. Dr. Seligman calls these larger-than-self entities the “commons”. He writes, “The maximal self, stripped of the buffering of any commitment to what is larger in life, is a setup for depression”. Once again, we seem to be setting ourselves up for a fall.

These five origins of depression should serve as a wakeup call. The biomedical world would have us believe that we have experienced an extreme evolution in the brain causing an entire generation to have “chemical” imbalances that create depression. That sounds very unlikely. A majority of depression is our own doing as a society; from what we teach children, to what we value, to what we expect, and from what we have disconnected from. By understanding these origins, we now know that this epidemic of depression is a societal created phenomenon. As such, we should have the power to turn back the tide of depression. The mind is changeable. Epidemics can be stopped with knowledge. For those of you wondering what Dr. Seligman writes about antidepressant medications, here is a sample: “The antidepressant drugs are as good an example of our overmedicated society as the use of tranquilizers to bring peace of mind or hallucinogens to see beauty.” We do not want an entire generation using antidepressant medications. Something must be done to undo the origins of depression. To start this transformation process, I recommend reading Dr. Martin Seligman’s book Learned Optimism for anyone who finds themselves in a funk.

For more information about strategies for breaking a pessimistic cycle of thought please read my article called “Throw Eeyore From The Train”.